The new decree relating to the state nursing diploma of 02.20.26 finally updates the 2009 benchmark to better meet the health needs of the population. Strengthened skills, prevention, coordination and clinical reasoning: the reform modernizes training. We also note that training increases from 4,200 hours to 4,620 hours and that internships in psychiatry will be compulsory. Analysis by the National Union of Nursing Professionals.
For more than fifteen years, nursing training has relied on the 2009 framework. A solid framework, but progressively disconnected from the reality of care: aging of the population, chronic diseases, home care, digital technology, interprofessional coordination. One in two nurses also judged this frame of reference to be “out of phase” with the field. The publication of the decree of February 20, 2026 relating to the state nursing diploma, which will come into force at the start of the 2026 school year, therefore marks a structuring step in aligning training with the skills now recognized by law and recent decrees. Beyond a simple educational update, it constitutes a lever for adapting the healthcare system to the needs of the population.
A reform made essential by changing health needs
The framework constitutes the backbone of nursing studies: expected skills, content, internships and evaluation methods. Since 2009, practices have evolved profoundly. The rise of complex care, telehealth, coordinated exercise and even the rise in prevention have created a growing gap between training and clinical reality.
The reform thus aims to update theoretical and clinical content, strengthen decision-making autonomy and better articulate university training and internship sites. It also promotes the overall approach to the person and the caregiver-patient relationship, at the heart of the quality of care.
This logic is consistent with the analyzes carried out by professional organizations: train caregivers capable of responding to fragmented health pathways, chronic situations and a growing demand for proximity.
A base maintained, but enriched to gain clinical relevance
The decree confirms the three-year license structure, 180 ECTS and theory-clinical alternation. But the overall volume is increased: training increases from 4,200 hours to 4,620 hours, distributed as follows:
– 2,310 hours of clinical teaching;
– 1,890 hours of teaching and educational supervision;
– 420 hours of independent knowledge appropriation work.
This educational choice meets a strong expectation: anchoring training in clinical reasoning and field experience. The reform favors a more understandable progression of skills, integrating scientific knowledge, reflexivity and analysis of complex situations.
The new framework is part of more clinical and more academic skills-based training. It prepares future nurses for broader missions: coordination of courses, structured prevention, use of digital tools and participation in research.
Several developments directly respond to the needs of the population:
– Strengthening prevention and public healthessential in the face of the burden of chronic diseases and aging.
– Development of coordination and teamworkconsistent with the rise of complex courses and coordinated exercise.
– Integration of digital healthnow essential in monitoring and therapeutic education.
– Global and relational approachreaffirming the place of the person and their loved ones in care.
Compulsory internships in psychiatry (at least 5 weeks) and pediatrics are also planned, in order to better prepare future graduates for the diversity of population needs. The framework introduces, among other things, a “a transversality of mental health notably through training aimed at better knowledge of mental health, psychological disorders and their identification, and actions to take in the event of a problem or crisis, the development of psychosocial skills and teaching in human and social sciences”
Training consistent with new nursing skills
The reform can only be understood in light of recent legislative developments. The practice decrees have broadened the areas of nursing intervention, notably opening the way to nursing consultation and prescription in certain fields.
The decree of February 20, 2026 relating to the state nursing diploma therefore aims to prepare students for these new responsibilities: clinical assessment, decision-making reasoning, patient orientation and pathway monitoring. Training must therefore anticipate the scope of autonomy defined by future regulatory texts.
The issue is population-based. The reform explicitly aims to better prepare future nurses for emerging needs : mental health, chronic illnesses, aging, prevention and local care.
It also responds to the transformation of places of care. The increase in home and outpatient care requires caregivers capable of autonomy, coordination and health education.
By strengthening the scientific dimension and analytical capacity, the reform also promotes the development of nursing science and the dissemination of evidence-based practicesessential to improve the quality and efficiency of the system.
Points of vigilance for a fully operational reform
If this decree constitutes a major step forward, several elements will determine its real impact. The organizations emphasize the need for educational support, means for simulation and clinical supervision.
The success of the reform will also depend on the ability to preserve the balance between university education and clinical anchoring, in order to avoid training that is too theoretical or disconnected from practice.
In a training where internships represent half of the course, mentoring constitutes much more than an educational modality. It is a professional mode of transmission based on observation, guided imitation, progressive practice and reflective feedback. At the patient’s bedside, the student learns not only technical gestures, but also relational posture, ethics of care, prioritization and clinical reasoning. This experiential knowledge, often implicit, is transmitted neither in lecture halls nor in textbooks. It is built in the relationship between the student and the experienced caregiver, in shared time and progressive trust.
Companionship and tutoring allow the experience to be transformed into reflective learning, an essential condition for developing clinical judgment. Without quality supervision, the densification of training risks resulting in an accumulation of experiences without real appropriation. Students need regular support to understand their successes, identify their room for improvement and maintain their motivation. Tutors need dedicated time and salary recognition for their commitment. Investing in tutoring means securing learning and strengthening the quality of care.
An unfinished reform to prepare the nurse of tomorrow
If the updating of the framework constitutes an expected step forward, it leaves open a structuring question: the duration of the studies. The government has chosen to maintain a three-year course, despite proposals to extend it to four years made by a large part of the profession and the academic community.
At the same time, the reform increases the overall volume of training to 4,620 hours, in order to comply with the European requirements set by the directive relating to the recognition of professional qualifications. This increase, essential from a regulatory point of view, translates concretely into a densification of the curriculum over an unchanged duration.
This choice raises questions. In the majority of European countries, nursing training is now part of four-year courses, allowing more progressive scientific, clinical and reflective development. The hypothesis of an extension had also been mentioned in recent legislative debates, a sign of an emerging consensus on the need to strengthen initial training.
The consequence is educational and human. Concentrating more than 4,600 hours over three years means a particularly intense pace for studentsbetween teaching, internships, evaluations and personal work. For comparison, most university degrees in science or letters total around 1,500 to 1,800 hours of supervised teaching over the same duration, leaving more room for the appropriation of knowledge and the maturation of skills.
This densification fuels a risk well identified by those involved in the field. : fatigue, stress, difficulties reconciling personal life and feeling of permanent pressure. However, the quality of training also depends on the ability of students to learn, reflect and develop their clinical reasoning under sustainable conditions.
The reform therefore marks an important step, but it also illustrates the limits of a transformation carried out over a constant period of time. Training the nurse of tomorrow requires not only new content, but also time to learn, analyze and build a solid professional identity.
A decisive step for the future of the profession and the healthcare system
The publication of the training order marks the end of a long wait. It reflects an ambition: to train nurses capable of responding to more complex, more territorialized and more preventive health needs.
By updating content, strengthening clinical reasoning and integrating coordination issues, the reform brings training closer to realities on the ground. It therefore constitutes a major lever for improving access to care, the quality of care and the relevance of pathways.
It now remains to translate this ambition into concrete educational practices. Because initial training does not only shape skills: it conditions the ability of the health system to respond to the challenges of tomorrow.
